Ethical Modelling

The ethics of care is based upon the theory of normative ethics developed by feminists in the second half of the twentieth century (Pettersen, 2011). It is essentially a theory which explores what defines right and wrong actions giving emphasis to the importance of

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relationships. The work of the American ethicist and psychologist Carol Gilligan (1992) is acknowledged as one of the founders of the ethics of care.

Ethics is a type of philosophy which is concerned with the investigation of morality and the way in which human conduct is guided and appraised by thinking (Bullock et al., 2000). Many individuals associate being ethical (or having morals) with how they personally feel about issues which may be influenced for example by beliefs in society, by law or according to religion (Baumhart, 1968). History is replete with rules for distinguishing right from wrong, from biblical “Thou shalt not kill”, (Exodus 20:13) to codes of professional conduct such as the Hippocratic Oath, “First of all, do no harm.” These examples help define what is considered acceptable behaviour.

Being ethical is not necessarily pre-determined by following one’s feeling, as to do so may deviate from what is ethical. If we take the example of equating ethics to religion, it goes without saying that most religions promote high ethical standards. Yet if ethics were to be restricted according to religious teaching then ethics would only be pertinent to religious people (Velasquez et al., 2010). Velasquez et al. offer an explanation for what ethics is, firstly they argue that it refers to “a well-founded standards of right and wrong that prescribe what humans ought to do” (paragraph 1) this usually arises out of obligation, fairness, specific virtues and benefits to society. Secondly they refer to ethics as the study and development of an individual’s ethical standards, which shape our moral beliefs and moral conduct.

Theories of ethics apply terms such as ‘ought’ and ‘should’ facilitating individuals to choose, justify and judge their action (Brody, 1988). Moral principles are the general standards of conduct and serve to form the ethical framework. Considering caring as merely a set of moral principles assumes that the concept is performed as an obligation or duty, (Kuhse, 1993; Stockdale and Warelow, 2000). An individual learns about right and wrong in many settings throughout their lives such as home, school, church and in social environments. This sense of right and wrong is so ubiquitous that it is often regarded as common sense. This then raises the question as to why so many ethical disputes and issues are evident in modern society (Resnick, 2011). Resnick offers an answer by

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suggesting that individuals, although recognising right and wrong, interpret and apply ethics, that are determined by life experiences and beliefs, in different ways.

Caring may also be viewed by some as a virtue, that is to say a quality that a person possesses in order to behave with moral principles or ethical ideals (Beauchamp & Childress, 1994). To view caring as virtuous also has its critics, believing that this stance encourages many problems such as emotional detachment, inefficiency and dependency (Cruzer, 1993; Allmark, 1998).

The question of caring as a virtue has been raised in the literature. Griffin (1980) argues that there is a principle definition of what it means to care and divides the meaning into two aspects, firstly the cognitive aspect, if one cares about something it is viewed as of value, concern or interest, whereby good is seen in what is being cared about. Secondly, the emotional aspect, if one cares about something then an array of emotion is felt in relation to it such as anger when injustice is done to a person one cares about. Emotions bring about desires and from these our actions arise.

Allmark (1998) identifies a weakness in the ethics of care and argues that its’ Achilles heel lies in its belief that care and caring are considered good values. Allmark is correct in his statement which can be supported by examples from history, examining the impetus for acts of war and conflict Hudson (1993, p.344) remarks that: “Hitler may well have cared for the success of the German people just as Mother Teresa cares for the comfort of the destitute of Calcutta. But would that have made him a virtuous man?” This example by Hudson is profound in that it serves to inform us that the emotion of caring for someone or something can exist for both good and bad reasons and therefore the existence of good caring and bad caring are evident.

Caring has been identified in the literature as being of significant value for professional behaviour and thereby facilitating good patient care. Gabard and Martin (2003) observed that caring in the context of health care, has several different meanings being described as a virtue (Davis, 2005) and a moral orientation based on an ethical theory of caring, this assumes that relationships with and connections to others are fundamental to ethical decision making (Branch, 2000). Compassionate caring, or benevolence, is seen as a

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virtue that implies doing good, it avoids basic harm out of a sincere care or concern for others. Originally described by Aristotle, virtue ethics relates to one’s moral character and is associated with experiencing feelings such as sympathy and regret.

Health care professionals are said to be virtuous practitioners if they possess characteristics such as self-motivation to care, empathy and are able to act altruistically towards their patients (Curzer, 1993). It is possible for an individual to act rightly but not virtuously as their motives are wrong, or have the right motives but act wrongly. Therefore for compassionate caring to exist in its purist form there must be an equal balance of motive and action (Beauchamp & Childress, 2008).

There are two themes that are pivotal to the ethics of care model, firstly, mutual interdependence and, second, emotional responsiveness. The former, mutual interdependence, acknowledges that many human relationships include people who are sick, vulnerable and dependent and that close attention to their needs is the ideal moral response to that situation (Gheaus, 2009). Demonstrating empathy for and interest in others creates the required characteristics of the moral relationship in this model. The second, emotional responsiveness is based on the expressing of emotions appropriately in the caring situation, for example, expressing compassion during the caring relationship is considered to be a morally important factor for the ethics of care (Beauchamp and Childress, 2008).

Baier (1985) gives a philosophical explanation of an ethics of care by stating that it is possible for individuals to do something for others out of love and trust. This takes into account human bonding and friendship, without abandoning the need for obligation or sound ethical decision making.

An ethics of care was described by Joldersma (2001) as a theoretical account of ethics, what it is and how it works in human life. Entering into caring relationships human beings become ethical agents who give and receive care through the virtue of caring. Developed mainly from the early works of Gilligan and Noddings, ethics of care is recognised for its significant effects politically and globally. It has helped to highlight the relevance of such issues as access to medical care, impacts of the environment on health,

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socioeconomic status, genetics, education and financial costs associated with caring practices.

The ethics of care has been criticised for being an underdeveloped theory (Baier, 1985; Carse and Nelson, 1996; Deveaux, 1995), for impartiality (Beauchamp and Childress, 2008), ambiguity of principles (Carse, 1991) and finally feminist reservations over the theories’ failure to acknowledge the oppression of women in their traditional roles as care givers (Sherwin, 1992). However, these ethical aims must be subjected to moral norms, which are only meaningful when based upon respect for others, as a result empathy and concern for others develops. Ricoeur uses the term Solicitude to summarize these characteristics. This is a complex theory and one which is difficult to articulate in light of its need for individual analysis and the difficulty in interpretation of the terms ‘self’ and ‘other’ (Atkins, 2005).